Provider Demographics
NPI:1699844704
Name:CHOLERA, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CHOLERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SQUIRE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:VILLA HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1479
Mailing Address - Country:US
Mailing Address - Phone:513-254-5348
Mailing Address - Fax:
Practice Address - Street 1:3860 RACE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4306
Practice Address - Country:US
Practice Address - Phone:877-845-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004374207R00000X
KY02229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31177376900OtherWKERS COMP
OH000000197447OtherANTHEM
KY64008170Medicaid
OH0734281Medicaid
OH311773769-001OtherMEDICAL MUTUAL
KY64008170Medicaid
OH311773769-001OtherMEDICAL MUTUAL
OH000000197447OtherANTHEM
KY1891601Medicare ID - Type UnspecifiedKY MEDICARE